title: Robotic versus vaginal urogynecologic surgery: a retrospective cohort study of perioperative complications in elderly women.
abstract: OBJECTIVE
  The primary objective was to compare perioperative complications after robotic surgery (RS) versus vaginal surgery (VS) for apical prolapse repair in elderly women. The secondary objectives were to (1) assess whether tools designed to predict surgical morbidity, the American Society of Anesthesiologists (ASA) class and the Charlson Comorbidity Index (CCI), are useful in the elderly urogynecologic population and (2) to classify complications during urogynecologic apical procedures using the Dindo classification system.
  
  
  METHODS
  We reviewed medical records of women 65 years or older who underwent RS or VS between March 2006 and April 2011. Procedures included robotic sacrocolpopexy and sacrocervicopexy, vaginal uterosacral ligament suspension, sacrospinous ligament suspension, colpocleisis, and Uphold vaginal mesh placement. We assessed preoperative risks using ASA and CCI classification and complications using Dindo grade.
  
  
  RESULTS
  There were 136 eligible cases (RS, 70; and VS, 66) during the 5-year study period. Women who underwent RS were younger (70 vs 74 years; P < 0.001). Vaginal surgery had more severe comorbidities as measured by the CCI (P = 0.012) but similar ASA profiles (P = 0.10). Robotic surgery had longer operative times (P < 0.001) but a lower estimated blood loss (P < 0.001). There were fewer postoperative complications in RS (P = 0.005). However, complication severity based on Dindo grade was similar between RS and VS, with most surgeries having no complications.
  
  
  CONCLUSIONS
  In the elderly women, RS was associated with fewer postoperative complications than VS. Overall, all procedures were associated with few complications, and either route may be reasonable in the elderly population.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA 30912, USA. brobinson.@gru.edu
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Robinson
authors.forename: Brent A
authors.initials: BA
authors.lastname: Parnell
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Sandbulte
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Geller
authors.forename: AnnaMarie
authors.initials: A
authors.lastname: Connolly
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Matthews
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006304:Health Status; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D018579:Patient Selection; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000009:adverse effects*; D014621:Vagina / Q000601:surgery*